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Dec. 14, 2010 -- Local and state health departments are better prepared than ever to deal with public health emergencies, but recession-related budget cuts threaten to reverse hard-won gains, a newly released analysis finds.

The readiness of individual states to handle large-scale public health emergencies was assessed in the eighth annual report, “Ready or Not? Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism,” commissioned by the health advocacy groups Trust for America’s Health and the Robert Wood Johnson Foundation.

Fourteen states met at least nine of 10 key indicators of emergency preparedness, while three states -- Arkansas, North Dakota, and Washington -- met all 10.

Iowa and Montana had the lowest scores, meeting just five of the 10 indicators.

“These scores reflect nearly 10 years of progress to improve how the nation prevents, identifies and contains new disease outbreaks and bioterrorism threats and responds to the aftermath of natural disasters in the wake of the September 11, 2001 and anthrax tragedies,” Trust for America’s Health Executive Director Jeffrey Levi, PhD, said in a Tuesday morning press conference.

Budget Cuts Threaten Post-9/11 Gains

More than three-quarters of states met at least seven of the 10 indicators, but Levi warned that budget cuts at the national, state, and local level may have already impacted readiness to respond to public health emergencies such as disease outbreaks, natural disasters, or acts of terrorism that impact public health.

Among the ominous signs:

33 states and Washington, D.C., cut funding for public health last year, and 18 states cut funding for the second year in a row. Georgia decreased funding the most by almost 35%, followed by Arizona and the District of Columbia, which cut funding by 23% and 18%, respectively.

Since 2008, 15% of public health work force has been cut at 2,700 health departments across the country.

In addition to cutting staff, many state and local governments have instituted work furloughs, hiring freezes, and shorter workweeks to address budget shortfalls.

Nearly three-quarters of Americans live in areas where local health departments have fewer employees than they did before the recession began.

Levi points out that the cuts would have been much worse without one-time funding infusions to public health from the 2009 stimulus bill and emergency appropriations for the H1N1 outbreak.

He added that the cuts are now hitting home and their potential impact cannot be overstated.

“The combined federal, state, and local budget cuts constitute an emergency for emergency health preparedness in the U.S.,” he said.

State-by-State Breakdown

In addition to maintaining funding for public health programs, the 10 indicators included in the analysis examined the ability of state and local health departments to gather and share information and respond to a prolonged emergencies affecting public health, among other measures.

Among the major findings:

Seven states are not able to share data electronically with health care providers: Alabama, Montana, Nevada, New Hampshire, New Mexico, Ohio, and South Carolina.

Ten states do not have an electronic surveillance system in place to report and exchange information: Alaska, Idaho, Illinois, Iowa, Kansas, Montana, Nevada, New Mexico, Oregon, and South Dakota.

Half of the states do not mandate all licensed child care facilities to have a written evacuation and relocation plan in the event of an emergency: Alaska, Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Missouri, Montana, Nebraska, New Jersey, Oregon, Rhode Island, South Dakota, Tennessee, and Wyoming.

Three states -- Hawaii, Iowa, and Montana -- and the District of Columbia reported not having enough staffing capacity to work five, 12-hour days for six to eight weeks in response to an infectious disease outbreak such as a flu pandemic similar to H1N1.

H1N1 Response Praised

James S. Blumenstock, who is chief program officer for the Association of States and Territorial Health Officials, said the response to the 2009 H1N1 swine flu outbreak highlights the progress that has been made in emergency preparedness during the past decade.

“The response showed that the country was much better prepared to respond to a pandemic than it would have been just a few short years ago,” he said. “In a short period of time the vaccine was developed and we were able to vaccinate 80 million Americans.”

Blumenstock echoed Levy’s concerns about the impact of budget cuts on public health emergency readiness, noting that federal funds for public health preparedness have been cut by 27% since 2005.

He called on federal lawmakers to resist slashing public health funding even further.

“Cuts in federal support are putting more than a decade of gains at risk at a time when the states are trying to cope with daunting and formidable budget shortfalls of their own,” he said.

SOURCES: “Ready or Not? Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism,” Trust for America’s Heath and the Robert Wood Johnson Foundation.Jeffrey Levi, PhD, executive director, Trust for America’s Health.James S. Blumenstock, chief program officer, Public Health Practice, Association of State and Territorial Health Officials.